Read Payor List 8-09.xls text version

COMMERCIAL PAYERS Enrollment Required Attachment availability

Payer Name 1 Point Solutions 1199 National Benefit Fund (NY) 21st Century Health & Benefits Inc. 3P Admin AAG - American Administrative Group (Formerly GBA) AAG - Benefit Plan Administrators Inc (UICI) AARP (Mechanicsburg, PA) A & I Benefit Plan Administrators A & I Benefit Plan Administrators (Portland, OR) Abrazo Healthcare (Phoenix, AZ) Abri Health Plan Access Administrators (El Paso, TX) Access Administrators (CA ONLY) AcClaim Accordia National (Charleston, WV) Acceptius (Benefit Management Inc. of MO) (BMI) ACEC Health Plans ACMG of South Carolina ACS Benefit Services (f.k.a. ACS Consulting Services) ACS Benefit Services (Winston- Salem, NC) ACS Benefit Solutions (NC) Activa Benefit Services LLC/Dental ADENTA Americhoice** Admin One Corporation Administration Services (ASI) Administration Systems Research Corporation (Grand Rapids, MI) Administrative Concepts Administrative Enterprises Inc. Administrative Services Only Inc. (Lynbrook, NY) Administrative Solutions Inc. (GA) Administrative Solutions Inc. (CA) Administrators West (OR) Administrators West (WA) ADN Administrators (MI) Advanced Benefit Administrators (OR) Advanced Benefit Resources (NY) Advanced Benefit Solutions (AZ) Advanced Insurance (AR)

Payer ID TFQ32 TLU12 59069 20413 37283 75240 AARP1 93044 CX044 PHP01 AHP01 AHS01 TLZ17 64071 87815 43178 TLX81 TLX92 72468 61474 61473 38255 TLU14 52133 TLX93 TLU87 TLU02 TLU86 TLX82 CX076 TLX94 TLZ40 TLX95 TLX96 TLX97 TLX98 TLY02 TLY01 TLY04

Eligibility

X **

X

Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section / *ecentral Insurance Managers customers should know that some Medicaid programs impose a fee for electronic verification of eligibility. These fees are charged per verification and are billed directly to the provider. Fees vary by Medicaid program. Contact your local Medicaid program for details. Please contact eServices Enrollment at 800.734.5561 for enrollment required forms and questions.

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COMMERCIAL PAYERS Enrollment Required Attachment availability

Payer Name Advantage Dental Plan Advantage Health Solutions Adventis Health System West (Roseville, CA) AEBS Aetna Affordable Health Choices (SM)- SRC Aetna DMO Aetna Life & Casualty Aetna Health Plans Aetna Select Affordable Benefits Admin (Burbank, CA) Affordable Benefit Administrators Inc. AFLAC (of Georgia) AFLAC - NY Plan AHCP-American Healthcare Partnership AIG (American General US Life) Alaska Children's Services Inc. (Grp#P68) Alaska Electrical Health & Welfare Fund Alaska Laborers Construction Industry (Grp#F23) Alaska Pipe Trades Local 375 (Grp#F24) Alaska Teamster Employer Welfare Plan (ATEWE) Alaska United Food & Commercial Workers Health & Welfare Trust (Grp#F45) Alaska UFCW ALICARE Allegiance Benefit Plan Management Allen Lund Co. (La Canada, CA) Allen Medical Claims Administrator Allied Administrators (San Francisco, CA) Allied Benefit Systems Allied Benefit Systems (Chicago, IL) Allied Building Inspectors (NY) Altus (RI) Always Care Benefits Amalgamated Life / Alicare (King of Prussia, PA) Amalgamated Life Ins. (NY) Ameriben Solutions (formerly IEC Insurance) American Administrators (West Des Moines, IA) American Administrators/dba Select Benefit Admin. (W. Des Moines, IA) American Association of Orthodontics (AAO-TPA) American Benefit Corporation (Huntington, WV) American Benefits Management (North Canton, OH) American Benefit Plan Administrators American Community Mutual Insurance

Payer ID 93524 52133 95340 TLY07 57604 68246 60054 60054 60054 95426 TLW02 58066 52080 TLW03 13545 91136 92600 91136 91136 TLY08 91136 TLX15 TLU15 TLU11 ALMC1 CX016 94177 TLX56 37308 TFQ23 50503 STR01 13343 TLY53 TLU23 42112 42137 TLU21 CX084 34187 TLU24 TLW04

Eligibility

X X X X X X X

Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section *ecentral Insurance Managers customers should know that some Medicaid programs impose a fee for electronic verification of eligibility. These fees are charged per verification and are billed directly to the provider. Fees vary by Medicaid program. Contact your local Medicaid program for details. Please contact eServices Enrollment at 800.734.5561 for enrollment required forms and questions.

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COMMERCIAL PAYERS Enrollment Required Attachment availability X X X

Payer Name American Dental Plan American Dental Plan of GA Inc. American Dental Plan of NC Inc. American Dental Payer of WI American Dental Professional Services (Milwaukee, WI) American Dental Professional Services (Milwaukee, WI) Repriced Claims American Dental Providers of AR Inc. American DentiCare (AR) American Healthcare American Health Group American Heritage Life Insurance Co. American Insurance Administrators (AIA)- Alumni Dent Program ONLY American Medical Securities American National Insurance Co. American Pioneer Life Insurance American Postal Workers Union Health Plan (APWU) American Prepaid Dental Plan of OH Inc American Prepaid Professional Services. Inc American Sentinel Insurance Inc. America's Choice Health plans LLC AmeriHealth Administrators (PA) Ameritas Life Insurance Corp. AMLICO- American Medical & Life Insurance Co. (Hicksville, NY) Amway Corporation Anchor Benefit Consulting Inc. (Maitland, FL) Antares Management Solutions (Westlake, OH) APA Partners of NY Apex Benefit Services APIPA (Arizona Physicians IPA) Appalachian Benefit Administrators (ABA) Arizona Pipe Trades Trust Fund Arkansas Best Corp- Choice Benefits ARM LTD Ascent Benefits (Phoenix, AZ) ASEA/ AFSCME Local 52 Health Benefit Trust ASI ASR Corporation ASR Health Benefits (Grand Rapids, MI) Associated Administrators TPA (AAI) Associated Benefits (IA) Assure Care (IL) Assure Care (MI)

Payer ID CX021 CX021 CX021 ADP01 TAD01 TAD02 CX021 TLY03 TLU25 AHG01 TLW75 TFQ43 CX001 74048 TLU26 44444 CX021 CX021 TLX55 TLX65 54763 47009 AML01 38255 53085 34192 16140 34196 TLW68 TLW65 TLY85 75278 TLY52 CX072 TLX61 TLU29 38265 TLU02 TLU30 TLU28 TLW69 TLW70

Eligibility

X

X X

X

X

X

X

Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section *ecentral Insurance Managers customers should know that some Medicaid programs impose a fee for electronic verification of eligibility. These fees are charged per verification and are billed directly to the provider. Fees vary by Medicaid program. Contact your local Medicaid program for details. Please contact eServices Enrollment at 800.734.5561 for enrollment required forms and questions.

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COMMERCIAL PAYERS Enrollment Required Attachment availability

Payer Name Assure Care (MN) Assure Care (OH) Assurant Employee Benefits Assurant Health (f.k.a Protective Life) Assurant Inc. (f.k.a First Fortis Life Insurance) Assured Benefit Administrators Asuris ASW/ Lifewise Athens Area Health Plan Select (Athens, GA) Atlanta Plumbers & Steam Fitters Local 72 Atlantic Dental Inc. / ADI (Medicaid Claims) (Coral Gables, FL) Atlantic Dental Inc. / ADI (Commercial Claims) (Coral Gables, FL) Atlanticare Atlas Administrators Alternative Risk Management (IL) Alternative Risk Management (OR) ATPA (Associated Third Party Administrators) (Pasadena, CA) ATPA (Associated Third Party Administrators) (OR) AultCare Dental (Canton, OH) Automated Benefits Services (ABS) Automated Group Administration (AGA) Automotive Machinists Local 289 (Grp#F32) Auxiant Avesta Group Insurance Avesis AZ Dept. of Health Services BAC Local 15 Welfare Fund (Kansas) Banner Health (AZ) BCI Administrators Inc. Bell Atlantic Bencomp National Corporation BeneCare Dental Plans Benefirst BeneMax Benefit & Risk Management Services Inc. Benefit Administration Services (Jackson, MS) Benefit Administrators Inc. (Knoxville, TN)) Benefit Administrative Systems (Homewood, IL) Benefit Coordinators Corporation (Pittsburgh, PA) Benefit Concepts Inc Benefit Concepts- EBD & A (RI) Benefit Group (NE) Benefit Inc. (MN)

Payer ID TLW72 TLW71 70408 39065 70408 TLX83 93221 37294 95691 TLU32 CX052 CX085 22304 TLU33 TLY90 TLY89 ATPA1 TFQ47 AULTC TLX91 37280 91136 TLY51 TLU34 86098 TLX87 A2051 TLY50 49153 60054 33192 23210 TLY88 BMX01 TLY45 TLU36 62121 36149 25145 TFQ46 TFQ22 TLU37 CDMN1

Eligibility

X X X

X X

X

X

X

X

Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section *ecentral Insurance Managers customers should know that some Medicaid programs impose a fee for electronic verification of eligibility. These fees are charged per verification and are billed directly to the provider. Fees vary by Medicaid program. Contact your local Medicaid program for details. Please contact eServices Enrollment at 800.734.5561 for enrollment required forms and questions.

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COMMERCIAL PAYERS Enrollment Required Attachment availability

Payer Name Benefits Management Inc. (MO) Benefits Management Inc (KS) Benefit Management Services (NC) Benefit Management Services (LA) Benefit Management Services- FEP Claims ( Baton Rouge, LA) Benefit Management Systems (Madison, MS) Benefit Plan Administrators (Roanoke, VA) Benefit Plan Administrators Co. (Eau Claire WI) Benefit Services Inc. Benefit Services of Hawaii Benefit Source (MI) Benefit Systems (IN) Benefit Systems & Services Inc. (BSSI) Benefits Inc. (Construction Suppliers Group Only) (Minneapolis, MN) Benemark (Mississippi) Benesight Benesys Inc. (Lafayette, LA) Benesys Inc. (GA) Benicorp Insurance (IN) Benicorp Insurance (MS) Best Life & Health Insurance Company (Irvine, CA) Better Health Plans of South California (Monroeville, PA) Blue Bell Benefit Trust Blue Care Dental Traditional Blue Care Family Plan Blue Plus of MN Bollinger Insurance (Short Hills, NJ) Boilermakers National Health & Welfare Fund Boon Chapman (Benefit Administrators) Bridgeport LLC of Missouri (St. Charles, MO) Brokerage Concepts Brokerage Concepts Inc. (PA) Brokers National Brokers National Life Assurance Company Broward Health Businessmen's Assurance (BMA) (NE) Butler Benefits (Davenport, LA) Cadent Administrators Cadent Underwriters CAI Insurance Canada Life Assurance Company (Atlanta, GA) Cannon Cochran Management Services (Metairie, LA) Capital Administrators (Rancho Cordova, CA)

Payer ID TLW73 48611 56139 TLU04 TLU05 37212 37118 39081 TLU03 TLZ27 TLU39 TLU40 36342 07000 BNMK1 87265 37248 58102 TLY48 TLY49 95604 32006 TLU42 TBT01 GWD01 CDMN1 TLX71 36609 74237 CX028 51037 TFQ18 CX032 CX032 37314 47009 42150 33192 33192 TLY06 80659 71057 68011

Eligibility

X

X X

X

X X X

Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section *ecentral Insurance Managers customers should know that some Medicaid programs impose a fee for electronic verification of eligibility. These fees are charged per verification and are billed directly to the provider. Fees vary by Medicaid program. Contact your local Medicaid program for details. Please contact eServices Enrollment at 800.734.5561 for enrollment required forms and questions.

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COMMERCIAL PAYERS Enrollment Required Attachment availability

Payer Name Capital Dental of Houston, TX Caprock Health Plan Careington Corporation Carolina Summit Healthcare (OH) Carpenters Combined Funds (PA) Carpenters Health & Welfare (Los Angeles, CA) Carpenters Health & Welfare (Philadelphia, PA) Carpenters Health & Welfare Trust Fund of St. Louis Caterpillar Inc.** CBCA Administrators (Fort Worth, TX) CBCA Administrators (Formerly HRM) CBCA- Comprehensive Benefit & Claims Administrators CBSA-Corporate Benefit Services of America (Minneapolis, MN) CCPOA CDO Technologies CDPHP- Capitol District Physicians Health Plan (NY) CDS Group Health (Sparks, NV) Cement Mason's Union Local 502 Cement Masons & Plasterers Health (Grp#F16) Cement Masons & Plasterers Local 518 (Kansas) Central Laborers Local 703 (FL) Central PA Teamsters Health & Welfare Fund Central Reserve (Latham, NY) Central Reserve Life (Eagan, MN) Central Reserve Life Insurance Company (Cleveland, OH) Central States Health & Welfare Fund (IL) Central United Life Insurance Century Planners Champva-HAC CHEC (Subsidiary of Sprint) Cherokee Insurance Co. (MI) Chesterfield Companies (OH) Chesterfield Resources Inc (Akron, OH) Chesterfield Resources Inc (Uniontown, OH) (a.k.a. Salvation Army) Chicago Regional Council of Carpenters Children of Women Vietnam Veterans - VA HAC Choice Plus (TRW) Christian Brothers Services CIGNA (Connecticut General) CIGNA Dental Health (CDH DMO) CIGNA Flex Care (NM Only) (Phoenix, AZ) CIGNA Voluntary Citizens Security Life Insurance

Payer ID CX037 TLU47 TLY44 56195 TFQ25 TLU49 TLW16 25125 37060 55438 41170 TLW14 41124 TLZ03 87065 TLW07 88022 TLW85 91136 A2005 TLZ15 TLU51 TLZ08 34097 TLW76 36215 TLY42 TLY39 84147 TLX40 TLY41 TLA11 TLU92 34154 TLY40 84147 60054 61271 62308 10050 TLX70 59225 CX071

Eligibility

X **

X X X X

X X X X

Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section *ecentral Insurance Managers customers should know that some Medicaid programs impose a fee for electronic verification of eligibility. These fees are charged per verification and are billed directly to the provider. Fees vary by Medicaid program. Contact your local Medicaid program for details. Please contact eServices Enrollment at 800.734.5561 for enrollment required forms and questions.

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COMMERCIAL PAYERS Enrollment Required Attachment availability

Payer Name Citizens Security Life Insurance (Louisville, KY) City of Crown Point City of Lafayette City of Mesa Civic Smiles (MN) Civil Service Employees Association (CSEA) CL Frates and Company - OSMA Health Claim Management Services (WI) Clarendon's Healthy Kids Claredons Kids CHIP Program (EPO) Clayton County Self Funded Dental Plan CNIC Health Solutions (Colorado Springs, CO) Coastal Administrative Services (CA) Columbian Life Insurance Company Columbian Mutual Insurance Company Combined Insurance Claims (FL) Combined Insurance Services (Ocala, FL) Community Claims Administration Community Connection (Phoenix, AZ) Community Health Choice Community Health Electronic Claims/CHEC/Web Tap Comp Benefits Dental & Vision Company Comp Benefits Direct Inc Comp Benefits of AL Inc. Comp Benefits of GA Inc COMP- Ohio (Austintown, OH) Comp Dent USA/ Comp benefits (Chicago, IL) Comp Dent of AL Inc Comp Dent of GA Inc Comp Dent of IL Inc Comp Dent Preferred Networks Inc Companion Life (Columbia, SC) Complete Benefit Solutions (SC) Comprehensive Benefits Administrator Inc. Compensation Programs of Ohio Compton Inc. Concordia Plus Concordia Preferred Conexis (CA) CONN EN Life Insurance Co. Connecticut Carpenters Health Fund (Hamden, CT) Connecticut General (see CIGNA) Continental Dental

Payer ID TLU52 TFQ07 TFQ06 TLW43 CX026 CX054 CX075 CMS01 33192 TLX41 CCS01 TLZ05 77052 TLX77 TLX77 TLU53 TCC01 26231 PHP01 TLX42 75261 CX021 CX021 CX021 CX021 34177 CX021 CX021 CX021 CX021 CX021 77828 TSCS1 03036 34177 TLX25 CX007 CX007 TFQ13 TLX09 37307 62308 62308

Eligibility

X X

X X X X X X X X X X

X X

X X

X X

X X

X

Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section *ecentral Insurance Managers customers should know that some Medicaid programs impose a fee for electronic verification of eligibility. These fees are charged per verification and are billed directly to the provider. Fees vary by Medicaid program. Contact your local Medicaid program for details. Please contact eServices Enrollment at 800.734.5561 for enrollment required forms and questions.

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COMMERCIAL PAYERS Enrollment Required Attachment availability

Payer Name Continental General (Latham, NY) Consociate Dansig Inc. (Decatur, IL) Consolidated Group Dental Cook Group Health Plan Cooperative Benefit Administrators (CBA) Core Five Core Management Resources Group (Macon, GA) Core Source (Little Rock, AR) Core Source (AZ, MN) Core Source (IA) Core Source (NC, IN) Core Source (OH) Core source (PA, MD, IL) Corestar Corporate Benefit Services of America (CBSA) Corporate Benefit Services Inc. (Charlotte, NC) Countrywide Info Services Covenant Administrators (Atlanta, GA) Coventry Health Care National Network (f.k.a First Health) Coventry Health Care of Georgia Creative Plan Administrators (MD) Crescent Dental Crescent Dental- Meritain Health CSEA Employee Benefit Plan CT Carpenters Health Fund CT Pipe Trades Health Fund Local 77 Custom Benefit Administrators (La Crosse, WI) Custom Care (Southwestern Bell-Exec) Custom Design Benefits Inc of OH D Edward Wright TPA Dakota Care Dart Container Corporation Dart Management Corporation (Madison, MI) Delta Claim Payers (NY) Delta Health Systems DeneX Dental/SG Denta Benefits DentaQuest (DC & MD) Dental Benefit Providers** Dental CPM Delta Care USA (Claims only) Delta Community Dental Care of MN Delta Premier (MA)

Payer ID TLZ07 37135 61305 35149 52132 TFQ74 58231 75136 41045 TFQ37 35180 35183 35182 41045 41124 56116 TFQ35 58102 87043 25148 37320 TLU54 CX074 CX054 TLU56 TLU55 39170 60054 82056 DEW01 TFQ60 TLX43 06172 TFQ14 94235 CX049 CX007 04356 52133 TLU57 DDCA2 CDMN1 TLZ37

Eligibility

X

X

X X X

X

X

X

X X X X X ** X X X X

Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section *ecentral Insurance Managers customers should know that some Medicaid programs impose a fee for electronic verification of eligibility. These fees are charged per verification and are billed directly to the provider. Fees vary by Medicaid program. Contact your local Medicaid program for details. Please contact eServices Enrollment at 800.734.5561 for enrollment required forms and questions.

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COMMERCIAL PAYERS Enrollment Required Attachment availability X

Payer Name Dental Care Plus Management Corp. Dental Comp Inc (WI) Dental Comp Dental Health Associates (N. Hollywood, CA) Dental Network (Townson, MD) Dental Network of America (BCBS of IL, TX, NM) Dental Pay Inc. / The Dental Shop Dental Select** Denti-Cal DentiCare Inc DentiLease Desert Mutual Benefit Administrators Destiny Health Plan Detroit Laborers (Metropolitan) DC37 DDS insurance DH Evans Diamond Dental of Arkansas Inc Dina Dental (Sugarland, TX) Direct Reimbursement Plan (Newman, GA) District 1199 Health & Welfare District Council 37 Health & Welfare Fund District Council 57 Benefit Fund Diversified Administration Corp (Maryland) Diversified Group Administrators Dominion Dental (DHMO & Commercial) DSCC (Div. of Special Care Children) Dunn & Associate Benefits Administrators (Columbus, IN) Dutcher Insurance E3 Health Inc. Eastern Life & Health** EBC Mid America Inc (KY) EBS Benefit Solutions ECIT Dental Plans Educators Mutual Insurance Assoc. (EMIA)-UT EHI/ EMPHESYS/ Employers Health** Electrical Workers Benefit Fund #369/ IBEW Local 369 Electrical Workers Benefit Fund #369/ IBEW Local 481 Elder Health Elmco Insurance EMIA (Educators Mutual Insurance Assoc.) Employee Benefit Administrators (Pembroke, MA) Employee Benefits Claims of Wisconsin Inc.

Payer ID CX035 TLX01 CX017 DHA01 CX034 DNOA1 TLW24 DSL01 94146 CX021 CX021 TFQ56 TLX84 A1004 HSP01 TLW96 CX065 CX021 CX090 TLX69 TLW78 HSP01 TLW34 CX040 TLW78 DOM01 TLX44 35186 TLZ04 75232 TLZ28 TLZ42 CX043 TLU58 CX079 73288 TLW28 EWF01 52192 TLW86 CX079 CX012 TLW29

Eligibility

X X X ** X X X X

X

X X

X **

X **

X

Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section *ecentral Insurance Managers customers should know that some Medicaid programs impose a fee for electronic verification of eligibility. These fees are charged per verification and are billed directly to the provider. Fees vary by Medicaid program. Contact your local Medicaid program for details. Please contact eServices Enrollment at 800.734.5561 for enrollment required forms and questions.

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COMMERCIAL PAYERS Enrollment Required Attachment availability

Payer Name Employee Benefit Concepts (Farmington Hills, MI) Employee Benefit Consultants Inc. (EBC) (OH, WI, NM, KY)) Employee Benefits Corporation Employee Benefits Management Corp of Ohio (EBMC) Employee Benefit Management Services Inc. (EBMS) Employee Benefit Services of LA (EBS) Employee Benefit Services (NE) Employee Benefits Plan Administration Inc. (EBPA) Employee Group Services (EGS) Employee Plans LLC Employee Security Inc. (Columbia, MD) Employer Plan Services Inc. (Houston, TX) Employers Dental Trust Employers Direct Health Employers Direct Health- Employee Plan Employers Health Insurance** Employers Life Insurance Corp. (SC) Employers Mutual Inc. (Jacksonville, IL) Encore Health Network (IN) ENH Medical Group IPA Engineers Joint Welfare Fund/ IUOE (NY) Enstar Natural Gas (Grp#P61) EPOCH Group LC (Overland Park, KS) EPOCH Group LC (St. Louis) EQUICORE (Cigna) Equitable Plan Services (Oklahoma City, OK) Erin Group Administrators (PA) ERISA/ Compusys (Austin, TX) E.S. Beveridge & Associates Essex Dental Benefits E-V Benefits Management Inc. (Columbus, OH) Evans DH Associates Inc. ExclusiCare Family Care Claims (TX) Family Health Administrators Family Members Dental Plan (FMDP) (Military) Fara Benefit Services FCE Benefit Administrators (TX) Fed Ex Freight Health Benefit Federated Mutual Insurance Company Fidelo Insurance Co. First Administrators (IA) First Ameritas Life Insurance Corp. of NY

Payer ID 38241 37257 TLW79 CX025 81039 41198 47009 03036 CX022 35112 54098 CX031 TLW30 75232 75236 73288 TLW32 59297 TLY86 36364 TLW87 91136 TLU60 TLX13 62308 73126 CX046 74234 34108 43168 34159 25172 71412 TLX14 TLU61 CX002 TLU62 TLY84 TLU64 41041 TLU69 TLU67 72630

Eligibility

X X

X

X **

X

X

X

X

X

X

X

Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section *ecentral Insurance Managers customers should know that some Medicaid programs impose a fee for electronic verification of eligibility. These fees are charged per verification and are billed directly to the provider. Fees vary by Medicaid program. Contact your local Medicaid program for details. Please contact eServices Enrollment at 800.734.5561 for enrollment required forms and questions.

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COMMERCIAL PAYERS Enrollment Required Attachment availability

Payer Name First Care Health Plans First Care/ Southwest Life & Health First Choice Benefits First Choice Health Administrators First Commonwealth (IL) First Concord Group Inc. First Continental Life & Accident Insurance (Sugarland, TX) First Dental Health (FDH) First Fortis Benefits First Health (Downers Grove, IL) First Plan Blue (MN) First Reliance Standard (NY Business) Fiserv Health- Wausau Benefits/ Benesight Fitz Harris & Company Inc. (Farmington, NY) FL League of Cities Flexible Benefit Fund Flex Care Flex Compensation (MN) Florida Benefit Administrators Florida Hospital Waterman Florida Power & Light FMH Benefit Services Inc. Foreign Service Benefit Plan Formula Card Dental Formula Dental Fortis Insurance Company (Formerly Time Insurance) Foundation Benefit Admin. (FBA) - Boon Group Fourth District IBEW Fox Everett Inc. (Jackson, MS) Fox Everett Inc. (AZ) Fox Valley Welfare Fund (Elgin) Fox Valley Welfare Fund (Geneva) Fraternal Order of Police- Dental Division (Philadelphia, PA) Fringe Benefit Management (Formerly United Benefits) GCU Local 8-M & 96B Health & Welfare Fund GE Financial Assurance General Electrical Pensioners Gerber Life Insurance Co. - Student Insurance Gettysburg Gettysburg Insurance Services GHI New York (Group Health Inc.) GIC Ademnity Plan Gilsbar INC.

Payer ID TLX17 CX050 TLU68 TLY83 TLZ41 TLU65 CX090 TLU63 70408 87043 CDMN1 13317 39026 11244 TLX53 TLU70 60054 R7004 TLW93 48116 60054 48117 TLW97 LX050 TLU19 39065 BOONG TLX90 TLY81 64069 TLU71 TFQ71 CX041 59069 GCU01 TLW17 TLX72 74227 CX064 TLU74 13551 80314 07205

Eligibility

X

X X X X X X

X X

X

X

X

X

X X

X

Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section *ecentral Insurance Managers customers should know that some Medicaid programs impose a fee for electronic verification of eligibility. These fees are charged per verification and are billed directly to the provider. Fees vary by Medicaid program. Contact your local Medicaid program for details. Please contact eServices Enrollment at 800.734.5561 for enrollment required forms and questions.

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COMMERCIAL PAYERS Enrollment Required Attachment availability

Payer Name Glassworkers Health & Welfare Fund (GRP#F29) Global Healthcare (c/o People 1st) Golden Rule Insurance Company (Lawrenceville, IL) Golden West Dental (Woodland Hills, CA) (Blue Care Family Plan) Government Employee Hospital Association Inc. (GEHA) Great West Healthcare Great-West Health Care (f.k.a. American General) Group & Pension Administrators (GPA) (Richardson, TX) Group Administrators LTD Group Benefit Administrators (Salt Lake City, UT) Group Benefit Services (practices in MI, IN, IL & OH only) Group Dental Services of Houston Group Health Insurance (New York, NY) Group Insurance Services Center Inc. (MA) Group Link of Indiana (Indianapolis, IN) Group Resources Inc. (Atlanta, GA) Group Resources Inc. (Dallas, TX) Guaranty (DINA) Guardian Life Insurance Co. of America Guarantee Trust Life Ins. Co. (Medicare Supplement Policies ONLY) G.W. Lisk Co. H & A Administrators Harrington Benefit Services (Formerly TPC Management) Harvard Pilgrim Healthcare (HPHC) Student Insurance Hawaii Dental Service (HDS) (requires HDS#) Hawaii Medical Assurance Association (HMAA) HCH Administration (NM) HDM Benefit Solutions Inc. Health Alliance (IL) Health Benefit Claims Dept. Health Choice of AZ- Claims ONLY Health Claims Service / HCS (Boise, ID) Health Comp TPA (Fresno, CA) Health Cost Solutions (TN) Health Economics Group Inc. Health First TPA Health First of Austin Health Future LLC (Medford, OR) Health Link (MO) Health Management Systems- AKA- Managed Dental Care Network Health Net (CA) Health Net (OR) Health Network America

Payer ID 91136 TLX45 TLW18 GWD01 44054 80705 63665 48143 36338 TFQ50 CX011 CX036 13551 37276 CX015 TLY74 TLZ21 CX090 64246 TLW81 TLX20 LX059 06131 74227 DEHI1 TFQ61 TLU97 TLU98 TLW88 TLX24 62179 82018 85729 TLA18 CX039 TLW61 75289 30946 TFQ27 84097 TLW20 52133 20199

Eligibility

X X

X X X

X

X

X

Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section *ecentral Insurance Managers customers should know that some Medicaid programs impose a fee for electronic verification of eligibility. These fees are charged per verification and are billed directly to the provider. Fees vary by Medicaid program. Contact your local Medicaid program for details. Please contact eServices Enrollment at 800.734.5561 for enrollment required forms and questions.

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COMMERCIAL PAYERS Enrollment Required X Attachment availability

Payer Name Health Now ( Buffalo, NY) Health Partners (Jackson, TN) Health Partners of Minnesota- Commercial Health Partners of Minnesota- Medicaid (MN) Health Plan Inc. (Westborough, MA) Health Plan of Nevada Health Plan Services (Tampa, FL) Health Plex Inc. (Uniondale, NY) Health Plex Inc.- Child Health Plus (CHP)/ Family Health Plus (PHP) Claims ONLY Health Resources Incorporated (HRI) Health Risk Management (HRM) (CBCA Administrators) Health Traditions- MMSI (Rochester, MN) Healthcare Management Administrators Inc. Healthcare Partners /MD America Health SCOPE Benefits Inc. Healthsmart Accell (TX) Healthspan Healthsource Provident Administrators (Cigna) Healthy Families (CA) Heller Associates Hewitt Coleman & Associates (SC) HMSA (Hawaii Medical Services)- Commercial HMSA (Hawaii Medical Services)- Federal Hometown Health Plan Nevada (Reno, NV) Hoosier Dental (Indianapolis, IN) Hotel Employees & Restaurant Employees Health Trust HRM Claim Management Humana (non military) (WI)** IATSE (International Assoc. of Theatrical Stage Employees) IBA Self Funded Group (Kalamazoo, MI) IBEW Local Union 270 (Oak Ridge, TN) IBEW Local 38 IBEW Local 117 IBEW Local 176 (In State Only) IBEW Local 176 (Out of State) IBEW Local 461 IBEW Local 464 IBEW Local 481 IBEW Local 1249 IBEW Welfare Trust Fund (IL)

Payer ID 55204 62157 CX009 CX010 CX055 TLY56 59140 11271 TLZ11 CX019 41170 HTD99 HMA01 TLU93 71063 75237 TFQ59 62308 TLZ34 TFQ40 TFQ15 HMSA1 HMSA2 88023 CX015 91136 41170 73288 IAT01 38234 TLZ16 A1317 A1117 TLW90 TLW91 A1461 A1464 A4681 TLW62 TLX59

Eligibility

X

X

X X

X **

Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section *ecentral Insurance Managers customers should know that some Medicaid programs impose a fee for electronic verification of eligibility. These fees are charged per verification and are billed directly to the provider. Fees vary by Medicaid program. Contact your local Medicaid program for details. Please contact eServices Enrollment at 800.734.5561 for enrollment required forms and questions.

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COMMERCIAL PAYERS Enrollment Required Attachment availability

Payer Name I.B.P.A.T District Council # 11 I.E. Shaffer (West Trenton, NJ) Illinois Central Hospital Association (Tinley Park, IL) IMA Management Inc. (LA) Indian Health Services Indiana Carpenters Welfare & Pension Fund (Indianapolis, IN) Indiana State Council of Roofers Indiana Teamsters Health Benefits Fund (Indianapolis, IN) InforMed LLC (Annapolis, MD) Insurance Administrator of America Inc. Insurance Claim Services (AL) Insurance Claim Services (IL) Insurance Design Administrators (Oakland, NJ) Insurance Management Administrators of Louisiana Insurance Management Services (Elko, NV) Insurance Programmers Inc. Insurers Administrative Corporation Insurex Benefit Administrators Integra Administrative Group (Seaford, DE) Interactive Medical Systems Inc. Intercare Benefit Systems Inc. International Brotherhood of Boilermakers IntraHealth Solutions (formerly D. Edward Wright Inc.) Iowa Benefits Inc. (IBI) Iron Workers District (NY) IUOE Local 211 Jefferson Pilot / Guarantee Life Ins. Co. (GLIC) Jenkins & Associates (Jonesboro, GA) J.F. Molloy & Associates JFP Benefit Management Inc. JI Specialty Services Company (Austin, TX) JMH Health Plan (FL) John Alden Life Insurance Co. John Hopkins EMS John Morrell Company- AHBPA (Birmingham AL) JP Farley Corporation (Westlake, OH) JSL Administrators (GA) JSL Administrators (NC) JW Terrill Kaiser Permanente Dental Choice (Rockville, MD) Kanawha Insurance Co. (Lancaster & Greenville, SC)

Payer ID TLW82 22175 36600 TLW83 CDOK1 ICW01 TFQ03 35107 52196 TLY73 TLY72 TLY71 13315 TLW83 88006 TLW82 86304 TLY70 51020 TLW56 TLY69 36609 IHS01 41124 TLX28 TFQ24 JPF01 JEN01 61271 TLY67 TLW64 TFQ12 41099 TFQ66 38310 34136 TLY66 TLY65 TLY94 CX073 57038

Eligibility

X

X

X

Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section *ecentral Insurance Managers customers should know that some Medicaid programs impose a fee for electronic verification of eligibility. These fees are charged per verification and are billed directly to the provider. Fees vary by Medicaid program. Contact your local Medicaid program for details. Please contact eServices Enrollment at 800.734.5561 for enrollment required forms and questions.

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COMMERCIAL PAYERS Enrollment Required Attachment availability

Payer Name Kansas Building Trades (Topeka, KS) Kansas City Laborers Welfare Fund Kansas City Life Insurance Company (Kansas City, MO) Kesley Seybold Kempton Co./Kempton Group Admin. Key Benefit Administrators Inc. Keylink Solutions Klais & Company La Cruz Azul de Puerto Rico Laborers Southeast Health & Welfare Plan Lafayette Life Insurance Lawrence Paper Company (KS) LBA Health Plans (Timonium, MD) Liberty Dental Plan (Santa Ana, CA) Life Insurance Co. of Boston and New York LifeRe Lifewise Health Plan of Oregon Lincoln National (WI)** Lincoln Financial Group (f.k.a. Jefferson Pilot) (NE) Line Construction Benefit Fund Local 63 Health & Welfare (IL) Local 135 Health Benefits (Indianapolis, IN) Local 148 Health & Welfare Fund Local 1149 Baldwinsville, NY Local 118 Rochester, NY Local 182 Utica, NY Local 264 Cheektowaga, NY Local 294 Albany, NY Local 295 Welfare Fund Local 317 Syracuse, NY Local 375 Buffalo, NY Local 388 Dental Fund Local 449 Buffalo, NY Local 529 Elmira, NY Local 669 Albany, NY Local 687 Potsdam, NY Local 693 Binghamton, NY Local 791 Rochester, NY Logistics Health (WI) Los Angeles Fireman's Relief Association (LAFRA) Lovelace Sandia Health Plan

Payer ID KBT01 A2032 CX058 TLX46 73100 TLX29 TPA01 34145 95325 LSH01 TFQ05 TLU99 52193 CX083 78140 47009 93093 73288 CX061 LCB01 TLZ22 35107 PCM01 NYT01 NYT01 NYT01 NYT01 NYT01 TFQ17 NYT01 NYT01 TLX08 NYT01 NYT01 NYT01 NYT01 NYT01 NYT01 TFQ26 LAF01 90328

Eligibility

X X **

X X X X X X X X X X X X X

Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section *ecentral Insurance Managers customers should know that some Medicaid programs impose a fee for electronic verification of eligibility. These fees are charged per verification and are billed directly to the provider. Fees vary by Medicaid program. Contact your local Medicaid program for details. Please contact eServices Enrollment at 800.734.5561 for enrollment required forms and questions.

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COMMERCIAL PAYERS Enrollment Required Attachment availability

Payer Name Machigonne Benefit Administrators MAG Employee Benefits Magna Care Local 342 Mailhandlers Benefit Plan/ CAC Maloney Associates MAMSI (Frederick, MD) Managed Care of North America (MCNA) Manulife W.J. Sutton Co. Marsh Advantage Marsh Advantage America Mashantucket Pequot MBA Benefit Administrators Inc (SLC, UT) MBA of Wyoming (Worland, WY) MBS (MedCost Benefit Services) MCNA Dental MEDICA (Minneapolis, MN) MEDICA MN Public Program Medical Benefits Adm. Inc./ Medben (Newark, OH) Medical Benefits Administrators Medical Benefits Companies (OH) Medical Benefits Mutual (MedBen) Medical Mutual of Ohio (MMO) (only OH residents) Medical Mutual of Ohio Medical Network of Colorado Springs MEGA Life & Health Co. (Student Ins. Div.) MEGA Life & Health Insurance Co. Memorial Herman Health Network Mennonite Mutual Aid Mercer Administrators Mercy Care MetLife (formerly Travelers) Metro Health Plan (Minneapolis, MN) Metropolitan Detroit Laborers MFC & Health Plus Peoria MGM Mirage Health Plan MHP (Metropolitan Health Plan) Michigan Conference of Teamsters Michigan Laborers Healthcare Fund (Kalamazoo, MI) Michigan Regional Council of Carpenters Employee Benefits (Tory, MI) Michigan State Painters

Payer ID 10317 TLW30 TFQ73 62413 TLX08 CX033 65030 98010 CX023 TFQ31 TLU77 87065 87065 56205 65030 CX026 CX026 74323 CX024 74323 74323 CB833 29076 84600 74227 59226 MHHNP MNM01 CX023 TLW15 65978 MHP01 A1004 23550 TFQ70 CDMN1 DELTA A1432 38238 A1404

Eligibility

X

X X

X X

X

X

X

Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section *ecentral Insurance Managers customers should know that some Medicaid programs impose a fee for electronic verification of eligibility. These fees are charged per verification and are billed directly to the provider. Fees vary by Medicaid program. Contact your local Medicaid program for details. Please contact eServices Enrollment at 800.734.5561 for enrollment required forms and questions.

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COMMERCIAL PAYERS Enrollment Required Attachment availability

Payer Name Mid-America Associates Inc. Mid American Health (NE) Midland Benefit Administrators Inc. (MI) Midland Benefit Administrators Inc. (NE) Midlands Choice Midwest Dental Benefits (St. Paul MN) Midwest National Life Insurance Co. Midwest National Life Insurance Co. of Tennessee- Student Insurance Midwest Security Administrators Inc. Millrights Local 1102 Health & Welfare Fund Mississippi Administrative Services (MAS) (MS) Mississippi Select Health Care (Gulfport, MS) Missoula County Medical Benefits Plan MN Power MPEEBT/ MPE Services Inc. (Jackson, MS) MO-KAN Welfare Fund Morgan White Ins. Morris Associates Morris Associates (Indianapolis, IN) Motorola Inc. Mountain Claims Management Mountain States Administrative Services (Tucson, AZ) MS Administrative Services (ID) M.T.A. (CA) Mutual Assurance (Oklahoma City, OK) Mutual of Omaha Ins. Co./ Mutually Preferred MVP Health Care N.W. International Association of Machinists (Grp#F39) N.W. Ironworkers Health & Security Trust (Grp#F15) N.W. Roofers & Employers Health & Security (Grp#F26) N.W. Textile Processors (Grp#F14) NAA (North American Administrators L.P.) (Nashville, TN) NABN (Cleveland, OH) National Association of Letter Carriers/ NALC National Automatic Sprinkler Industry National Benefit Administrators - NC National Benefit Administrators - NJ National Employee Benefit Administrations of PA National Elevator Industry Benefit Plans (NEIB) National Pacific Dental National Pacific of TX (NCFLEX)

Payer ID 37281 TLX73 TLU93 TLZ43 TLZ10 41101 TLY93 74227 TLZ36 A1402 TLY96 64088 37275 CDMN1 37233 TFQ20 52133 TLU78 35092 36111 TLU79 86040 TLY97 TFQ72 37256 71412 TLX30 91136 91136 91136 91136 65085 34159 53011 TLX23 56176 56175 TLW49 CX045 06128 CX057

Eligibility

X

X

X X

Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section *ecentral Insurance Managers customers should know that some Medicaid programs impose a fee for electronic verification of eligibility. These fees are charged per verification and are billed directly to the provider. Fees vary by Medicaid program. Contact your local Medicaid program for details. Please contact eServices Enrollment at 800.734.5561 for enrollment required forms and questions.

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COMMERCIAL PAYERS Enrollment Required Attachment availability X

Payer Name National Rural Letter Carrier Association National Telecommunications Cooperative Association Nationwide Health Plans (Dublin, OH) NCAS (Charlotte, NC) NCAS (Harrisburg, PA) NCAS (Fairfax, VA) Neighborhood Health Netcare of Life & Health Insurance (NLH) (Hagatna, GU) Neman Company New England Dental Administrators New World Claims Services (Niles, MI) New York Life Insurance Co. New York Teamsters Union Newman Company NGS American (Lake Forest, IL) Nippon Life Insurance Co. of America North America Administrators (NY) North America Administrators LP (TN) North American Benefit Network/ NABN (Cleveland, OH) North American Health Plans North Broward Hospital District North Carolina Health Choice North Carolina Health Choice for Children (Durham, NC) North Star Administrators Northshore University Health System Medical Group Northern California Pipe Trades Trust Northern Illinois Health Plan Northern Minnesota Dental Northwest Administrators Inc. Northwest Suburban IPA (Illinois) Northern Nevada Trust Fund Northwest Dental Services NOVA Healthcare Administrators Inc. (Grand Island, NY) NW Int. Assoc. of Machinists & Aerospace Eng. Benefit Trust Dental Program Nyhart (Indianapolis, IN) OBA Midwest TPA Ogden Benefits Administration (CA) Ogden Benefits Administration (NV) Ogden Benefits Administration (OH) Ohio AFSCME Care Plan

Payer ID 71412 52120 31417 75191 TLX64 75190 TLZ25 66055 TNC01 43351 38332 66915 NYT01 TFQ30 38225 81264 TLX02 65085 34159 TLX02 37314 TLY55 61472 47570 36364 TLW42 36347 LX062 91060 36346 88027 93525 16644 91136 37299 TLY87 TFQ39 TFQ41 TFQ42 OAC01

Eligibility

X

X

X

X

Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section *ecentral Insurance Managers customers should know that some Medicaid programs impose a fee for electronic verification of eligibility. These fees are charged per verification and are billed directly to the provider. Fees vary by Medicaid program. Contact your local Medicaid program for details. Please contact eServices Enrollment at 800.734.5561 for enrollment required forms and questions.

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COMMERCIAL PAYERS Enrollment Required Attachment availability

Payer Name Oklahoma Operating Engineers OK State Employees & Educators (EDS) Omaha Industry Construction Operating Engineers Local 37 Operating Engineers Locals 302 & 612 Health (Grp#F12) Operating Engineers- Region 20(CA) Oregon Dental Services (DD of Oregon)** Oregon Health Plan (OHP) Oregon Medical Assistance Program (OMAP) OSMA Health (CL Frates & Company) Oxford Health Plans (Colorado) Oxford Life Insurance (AZ) PA Faculty Health & Welfare Pacific Dental Benefits (Concord, CA) Pacific Dental Benefits (Las Vegas, NV) Pacific Dental Benefits (Houston, TX) Pacific Life & Annuity (Phoenix, AZ) Pacific Source Health Plans Pacific Union (CA) PacifiCare Dental & Vision HMO (Santa Ana, CA) PacifiCare Dental & Vision PPO (Santa Ana, CA) Paid Dental (TX) Painters Trust Association Paramount Advantage- HMO Elite Advantage Claims Paramount Advantage- Preferred Choices Paramount Advantage- Preferred Option Paragon Benefits Passport Health Plan (KY) Patient Advocates LLC (Portland, ME) Patriot Mutual Dental Programs (Minneapolis, MN) Paul Revere/ Provident Pavers & Road Builders Welfare Fund PDO Pearl Insurance PEHP (Public Employees Health Program) Peoples Benefit Life Insurance Company Peoples Health Inc. Pequot Plus Health Benefit Administrators Pequot Pharmaceutical Performax Inc (NY) Performax Inc. (PA)

Payer ID TFQ36 22521 TLW92 TLZ35 91136 TLY57 CDOR1 93525 93525 CX075 84104 TLX34 CX066 TLW59 TLW58 TLW57 67466 93029 CX056 CX060 CX053 TLX26 TLY91 TLY63 TLY61 TLY62 58174 CX091 10525 32069 47009 PRW01 68241 TLW79 CX080 52133 TFQ29 37121 37121 TLZ45 TLX32

Eligibility

X **

X X

X X X

Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section *ecentral Insurance Managers customers should know that some Medicaid programs impose a fee for electronic verification of eligibility. These fees are charged per verification and are billed directly to the provider. Fees vary by Medicaid program. Contact your local Medicaid program for details. Please contact eServices Enrollment at 800.734.5561 for enrollment required forms and questions.

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COMMERCIAL PAYERS Enrollment Required Attachment availability

Payer Name Personal Choice (PA) Personal Insurance Administrators Phoenix Health Plan (PHP) (AZ) Physicians Care (Grand Rapids, MI) Physicians Care Network (Rockford, IL) Physicians Health Association of Illinois Physicians Health Partners/ CDOC (CO) Physicians Health Plan (IN) Physicians Health Plan of Northern Indiana (Ft. Wayne, IN) Physicians Mutual (Lincoln, NE) Piedmont Insurance Group PIMA Health Systems Pinnacle Claims Management Inc. Pipe Fitters 597 (Chicago, IL) Pipe Traders Industry Health & Welfare Fund Pittman & Associates Planned Administrators Inc. Plasterers & Cement Masons Local 148 Health & Welfare Fund Plumbers & Steamfitters Local 440 Plumbers & Steamfitters Local 486 Poly America Medical & Dental Benefits Plans POMCO Porter County Government Postal Supervisors (MD) Prairie States Enterprises Inc. Preferred Care Preferred Care (FL) Preferred Care (NC) Preferred Dental Organization Preferred Health Plan (KY) Preferred Health Professionals (Freedom Dental) Preferred One / Preferred One Community Health Plan (MN) Premier Access Insurance Co (Sacramento, CA) Premier Dental Plan (MN) Primary Physician Care Inc. P.R.I.M.E. Prime West Prime West Health Principal Financial Group Principal Life Insurance Co. Priority Health (Grand Rapids, MI)

Payer ID TLX74 95397 PHP01 TLU02 36345 37136 TLX05 TLZ23 12399 CX068 TFQ33 TLX76 24735 PIP02 PIP01 37224 TLX33 PCM01 TLX04 TLW98 32680 16111 TFQ04 TFQ10 36373 16112 59291 56178 60054 TFQ28 31478 41147 CX078 CX029 56144 DX109 61604 LX049 61271 61271 38217

Eligibility

X

X

X

X

X X

X X

X X

Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section *ecentral Insurance Managers customers should know that some Medicaid programs impose a fee for electronic verification of eligibility. These fees are charged per verification and are billed directly to the provider. Fees vary by Medicaid program. Contact your local Medicaid program for details. Please contact eServices Enrollment at 800.734.5561 for enrollment required forms and questions.

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COMMERCIAL PAYERS Enrollment Required Attachment availability X X X X X X X X X

Payer Name Professional Benefit Administrators Inc. (Oak Brook, IL) Provident Life Prudential for Health Prudential Health Care HMO for Small Business's Prudential Health Care Health Maintenance Organization Prudential Health Care & Life Ins. Co. of America Prudential Health Care of America Prudential Health Care POS for Small Business's Prudential Health Care PPO for Small Business's PSC CUNY Welfare Fund Public Employees Health Program (PEHP) Puget Sound Benefits Trust (Grp#F25) Puget Sound Electrical Workers Trust (Grp#F33) Quad-Med LLC (Pewaukee, WI) Quality Benefits LLC Quality Plan Administrators Inc. (Washington DC) Qualmed- New Mexico RBMS LLC (Anchorage, AK) Regence Blue Shield of Washington Health Regence Northwest Health Regency Employee Benefits Regional Care Inc. (Scottsdale, AZ) Reliance Standard Life (Lincoln, NE) ReliaStar (CA) ReliaStar (Known as Core Star, formerly NW National Life) (MN) Renaissance Life & Health (Indianapolis, IN) Resource ONE Corp. Reynolds & Reynolds RH Administrators Risk & Benefit Management Services Riverside San Bernardino County Indian Health Inc. (Banning, CA) RMSCO Inc. (Syracuse, NY) Rochester Laborers Welfare Fund Rochester Public Schools (Rochester, MN) Rocky Mountain Life Dental Roofers & Waterproofs Local 136 H&W Fund Royale Resources S & S Healthcare Inc. S & S Health Strategies (OH) Safeguard (PPO) Safeguard (HMO)

Payer ID 36331 62308 68241 68241 68241 68241 68241 68241 68241 TFQ38 CX080 91136 91136 39197 TLW95 CX077 TLX48 91176 93200 93200 38221 47076 36088 80314 41045 RLHA1 TLX93 TLU81 TLX22 TLU80 50664 16117 TLX19 41625 84102 TRW01 RR001 TLW46 31441 CX030 CX048

Eligibility

X

X X

X X X

X

Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section *ecentral Insurance Managers customers should know that some Medicaid programs impose a fee for electronic verification of eligibility. These fees are charged per verification and are billed directly to the provider. Fees vary by Medicaid program. Contact your local Medicaid program for details. Please contact eServices Enrollment at 800.734.5561 for enrollment required forms and questions.

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COMMERCIAL PAYERS Enrollment Required Attachment availability

Payer Name Sage Technologies (fka Progressive Benefit Services) Sage Technologies (fka Cannon Cochran Management Srvs.) Salvation Army (Uniontown, OH) SAMBA Samba Federal Employee Benefit Assoc. (KY) Sanford Health Plan (Sioux Falls, SD) Santa Barbara Cottage Hospital SBA Atlantic Coast Health Plan Scan Health Plans Arizona Scan Long Term Care (Phoenix, AZ) School Claims Services LLC (PA) School District #1 Health & Welfare Fund Scott & White Seabury & Smith Secure Care Dental Secure Health Plan of GA Securian Dental Plan (Minneapolis, MN) Security Life Insurance Co. of America Security Life Insurance Co. of America (Schenectady, NY) Secures Group Inc. Select Administrative Services (SAS) Select Benefit Administrators (IA) Select Benefit Administrators (Portland, OR) Select Care (Coca-Cola) Select Health Sele- Dent Inc. PPO Self Funded Plans LLC (Naples, FL) Self Funded Plans Inc. (Cleveland, OH) Self Insured Benefit Administrators (Clearwater, FL) Self Insured Dental Services (SIDS) Self Insured Plans Inc. (FL) Self Insured Services Company (Sisco) Sentry Life Insurance Company (Stevens Point, WI) Serentas Dental Care Solutions Set Seg. Inc. Shasta Administrative Services (OR) Sheet Metal Workers Local 104 Health Care Plan (San Ramon, CA) Sheet Metal Workers Local 20 (Zenith) Sheet Metal Workers Local 46 Sheet Metal Workers Local 85 Sheet Metal Workers Local 91

Payer ID 37137 37105 34154 37259 TFQ67 91184 37288 TLU82 73172 20460 TLW27 TLW26 TLX49 CX023 86057 28530 93742 TLX77 CX092 TLW45 64088 TFQ49 CX018 60054 CX107 TLU20 36404 34131 59111 CX076 TLX16 CX020 39033 CX038 38610 TLW25 38238 30920 TLW54 TLW55 SMW01

Eligibility

X X

X

X

X

Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section *ecentral Insurance Managers customers should know that some Medicaid programs impose a fee for electronic verification of eligibility. These fees are charged per verification and are billed directly to the provider. Fees vary by Medicaid program. Contact your local Medicaid program for details. Please contact eServices Enrollment at 800.734.5561 for enrollment required forms and questions.

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COMMERCIAL PAYERS Enrollment Required Attachment availability

Payer Name Sheffield, Olson, & McQueen Shenandoah Life Insurance SHN Employee Dental Sierra Health Services SIHO Sinclair Health Plan Smith Administrators (TX office) Smith Administrators (UT office) South Central Preferred-PPO York PA (HIS Gateway payer) South FL Community Care Network- NBHD South Point Hotel & Casino (Las Vegas, NV) Southern Alaska Carpenters Trust Southern Benefit Services Southern California Pipe Traders Southern Electrical Health Fund (Chattanooga, TN) Southern Group Administrators Southland National Insurance Corp (AL) Southwest Benefits Southwest Preferred Dental Org Southwestern Bell (Exec. & Custom Care) Southeastern Service Employees International Union (SEIU) Spina Bifida VA-HAC SRC (Strategic Resource Company) SRT Administrators St. Tammany Federation of Teachers St. Therese Physician Association (Rockford, IL) Standard Insurance (OR) Standard Insurance Company (NY) Star Dent StarHRG/ CIGNA Voluntary (Phoenix, AZ) Star Health Starmount Life Insurance Company State Auto (Columbus, OH) State Farm State of Texas Dental Plan Stewart C Miller Co. Sterling & Sterling Stoner and Associates (Cincinnati, OH) Stowe & Associates (Atlanta, GA) Strategic Outsourcing Inc. (SOI) Student Insurance

Payer ID 41143 CX067 TLX11 76342 TLY60 84076 TLW21 TLX63 23266 37314 35227 TLX62 37318 TLW41 SEF01 56131 TLX75 CX051 SPD01 60054 SEI01 84147 TLW40 TLY99 TLU84 37116 93024 13411 CX090 59225 CX090 STR01 46450 TFQ79 57254 TFQ08 TLW31 31121 58128 TLX60 74227

Eligibility

X X X

X X

X X

X

Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section *ecentral Insurance Managers customers should know that some Medicaid programs impose a fee for electronic verification of eligibility. These fees are charged per verification and are billed directly to the provider. Fees vary by Medicaid program. Contact your local Medicaid program for details. Please contact eServices Enrollment at 800.734.5561 for enrollment required forms and questions.

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COMMERCIAL PAYERS Enrollment Required Attachment availability

Payer Name Student Insurance - Boston Mutual Life Ins. Co Student Insurance - Life Ins. Co of Boston & NY Student Insurance - MEGA Life & Health Ins. Co Student Insurance - Mid-West National Life Ins. Co of TN Student Insurance - Reliance Ins. Company Student Insurance - Reliance National Ins. Co SummaCare (Akron, OH) Sun Life & Health Insurance Co. (US) (formerly GLHIC) Sun Life of Canada Superior Dental Care Preferred Plan** Sure Circle TPA Symetra (Latham, NY) Tall Tree Administrators (SLC, UT) TDC (Greenbay, WI )** Teachers Health Trust (Las Vegas, NV) Teamster Construction Industry Welfare Trust Teamster Health Welfare Teamsters Local 72 Health Fund Teamsters Local 377 Teamsters Local 618 Health Fund Teamsters Local 671 Health Fund Teamsters Local 677 Health Fund Teamsters Welfare Fund (MI) Texas CHIP Dental Services The Alumni Insurance Program The Benefit Group (TBG) The Boon Group The Chesapeake Life Insurance Company The Dental Companies (Greenbay, WI )** The Dental Concern (Greenbay, WI )** The Dental Network (Townson, MD) In State providers The Dental Network (MD or DC) Out of State providers The Loomis Company-TPA (Wyomissing, PA) The Mega Life & Health Insurance Co. (N. Richland, TX) The Physicians Assurance Corp. (TPAC) The Plan Handlers Inc The Union Labor Life Insurance Company (King of Prussia , PA) Third Party Administrator (Tucker, GA) Three Rivers Health Plans Inc. (Unison Health)** TIC International Inc. (Carmel, IN) TICUA Benefit Consortium

Payer ID 74227 74227 74227 74227 74227 74227 95202 67814 47009 31117 TLZ44 TLX77 88067 73288 88020 TCWT1 TLW39 TLW36 TFQ54 TLW37 TLW38 TLW35 DELTA CPPTX TFQ44 TFQ62 TLX67 74227 73288 73288 TDN01 TDN02 23223 59226 CX025 TLW84 13142 TLX54 25175 TIC01 TLX02

Eligibility

X X X **

X**

X

X ** X ** X

X

X **

Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section *ecentral Insurance Managers customers should know that some Medicaid programs impose a fee for electronic verification of eligibility. These fees are charged per verification and are billed directly to the provider. Fees vary by Medicaid program. Contact your local Medicaid program for details. Please contact eServices Enrollment at 800.734.5561 for enrollment required forms and questions.

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COMMERCIAL PAYERS Enrollment Required Attachment availability X

Payer Name Time Insurance (a Fortis company) TLC Administrators (CA) TML Group Benefits Inc. TPAC/ Employee Benefit Management Corp Total Administrative Services Corp. Total Benefit Services (IL) Total Benefit Services (LA) Total Claims Solution Total Dental Administrators (UT) Total Dental Administrators (AZ) Total Plan Services (TX) Tower Life Insurance (San Antonio, TX) TR Paul Inc. TranSmile (Sherwood, AR) Transwestern Insurance Travelers (MetLife) Tribal Health Partners (AZ) Tricare Active Reservists (Military) TriCare Family Member Dental Plan- TFMDP Trident Plan Administrators Trigon Insurance Co. (BC/BS of VA) Trusteed Plans Services Corporation (Tacoma, WA) Trustmark Insurance Trustmark Insurance (Lake Forest, IL) Trustmark Insurance (Clinton, IA) Tube Light Company Inc. Tufts Health Plan UCCI UFCW of Central Ohio UFCW of Cleveland UFCW Health & Welfare Fund of NE Pennsylvania UFCW Health & Welfare Fund of PA UFCW Local 1 UFCW Local 8 UFCW Local 1996 UFCW Local 400 Welfare Fund UFCW Local 400-5205 (Charleston, WV) UFCW Local 534 Welfare Fund UFCW Local 555 Health & Trust Fund UFCW Local 56 UFCW Local 655 Welfare Fund

Payer ID 39065 TLY38 TLU96 CX025 TLX01 TLZ14 TLU07 CMS01 TLY35 TLY36 TLY37 69493 37230 CX069 TLY33 65978 TLX99 CX002 CX007 TLY32 CB923 91078 61425 47009 TLW23 TLW09 TLZ24 CX007 UFC01 UFC02 TFQ09 TLW49 UFW01 TLZ02 TLW52 TLW94 A5205 TLW94 TFQ48 TLW67 TLW94

Eligibility

X X X X X

X X X

X X

X

X

X

X

Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section *ecentral Insurance Managers customers should know that some Medicaid programs impose a fee for electronic verification of eligibility. These fees are charged per verification and are billed directly to the provider. Fees vary by Medicaid program. Contact your local Medicaid program for details. Please contact eServices Enrollment at 800.734.5561 for enrollment required forms and questions.

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COMMERCIAL PAYERS Enrollment Required Attachment availability X X

Payer Name UFCW Local 881 Welfare Fund UFT Welfare Fund UMR- Harrington (Westerville) UMR- Harrington (Columbus) UMR-Lexington (Commonwealth Administrative Group) UMR- Onalaska UMR- San Antonio UMR- Wausau/ UHIS UniCARE Major Accounts (Mass Mutual) UniCARE Special Accounts (formerly John Hancock) Unifi Companies Unified Group Services Uniform Medical Plan Uniform Medical Plan/ Harrington Benefit Services Unimerica Dental** Union Labor Life Insurance Co. Union Security Insurance Company Unique Dentacare Unison Health Plan (Monroeville, PA)** United Administrative Services United Concordia (Fee for service) United Concordia (TRICARE FMDP & TDP) (Military) United Concordia Dental Plus United Health Care** United Health Care Insurance Co. of NY- Student Insurance United Healthcare of River Valley ( John Deere Health) United Food & Commercial Workers Union of Central OH (UFCW of Central OH) United Food & Commercial Workers Union of Central OH (UFCW of Cleveland) United Medical Alliance (CO) United Medical Resources / UMR - Cincinnati United of Omaha United Security Life United Security Life & Health Ins Co (Clinton, IA) United States Life Insurance Company Unity Health Insurance Corp. (Sauk City, WI) (Oral Surgery TMJ or Accident Claims ONLY) Unity Health Plan (NJ) Univera (NY)

Payer ID TLW94 62308 75196 95266 37237 79480 74223 39026 80314 80314 47009 35198 75243 75243 52133 13142 70408 52133 25175 TLY58 CX007 CX002 CX013 52133 74227 95378 UFC01 UFC02 84132 33108 71412 TLW89 36362 13545 66705 UNT01 16105

Eligibility

X X

X X X X X X X ** X X X X ** X X X X

X

X

Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section *ecentral Insurance Managers customers should know that some Medicaid programs impose a fee for electronic verification of eligibility. These fees are charged per verification and are billed directly to the provider. Fees vary by Medicaid program. Contact your local Medicaid program for details. Please contact eServices Enrollment at 800.734.5561 for enrollment required forms and questions.

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COMMERCIAL PAYERS Enrollment Required Attachment availability

Payer Name University of Denver University of Washington Students & Grad. (Grp#P67) Upper Peninsula Health Group (TPA) Upstate Admin Upstate Administrative Services Inc. US Benefits US Plan Administrators Utah - Idaho Teamsters Union (UT) Usable Life Valley Welfare Fund Varian Health Care Plan Verity National Group Veterans Administration Fee Basis Program Via Care Virtual Benefits Administrators Inc Washington Dental Service Washington Employers Trust Washington National (AZ) Washington State Council of County & City Employees Dental Trust (Grp#F36) Waterstone Benefit Administrators Watkins Associated Industries Web TPA ( Community Health Electronic Claims) Web TPA Inc of TX Webster Dental (Cigna) Welfare Fund of the Int'l Union of Operating Engineers Local (NY) Wells Fargo TPA (Formerly JSL Administrators) (Newman, GA) Wells Fargo Third Party Administrators Inc. (Charleston, WV) Wen- Neb Inc. West Coast Stationary Engineers Health (Grp#F13) Westlake Financial Group Inc. (Buffalo Grove, IL) West Lake TPA (Buffalo Grove, IL) Western Growers Assurance Trust/ Insurance Co. Western PA Electrical Employees Insurance Trust Western PA Teamsters Fund Western Teamsters Welfare Trust Westport Benefits Whatcom Medical Bureau William C Earhart (Portland, OR) William J Sutton & Co. LTD (Ontario) Wilson McShane Corporation

Payer ID TFQ52 91136 37324 TLU73 TLW47 TLW48 TLW22 TFQ51 76031 TFQ68 60054 75256 12116 TLX51 TLY94 91062 37294 TFQ11 91136 73155 TLU85 75261 59332 10050 TLX10 37272 87815 TLW51 91136 90560 TLX18 24735 TLW34 TLW33 91060 TLW08 84098 93050 98010 CDMN1

Eligibility

X

X

X

X

Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section *ecentral Insurance Managers customers should know that some Medicaid programs impose a fee for electronic verification of eligibility. These fees are charged per verification and are billed directly to the provider. Fees vary by Medicaid program. Contact your local Medicaid program for details. Please contact eServices Enrollment at 800.734.5561 for enrollment required forms and questions.

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COMMERCIAL PAYERS Enrollment Required Attachment availability X

Payer Name Wisconsin Auto & Truck Dealers Assoc. (WATDA) Woods & Grooms Benefit Services (Columbus, IN) Worksite Benefit Services WPS Health Insurance Zenith Administrators (AZ) Zenith Administrators (San Francisco, CA) Zenith Administrators (Los Angeles, CA) Zenith Administrators (CO) Zenith Administrators (IL) Zenith Administrators (IN) Zenith Administrators (KY- Louisville 1) Zenith Administrators (KY- Louisville 2) Zenith Administrators (LA) Zenith Administrators (MA) Zenith Administrators (MI) Zenith Administrators (MN) Zenith Administrators (MO) Zenith Administrators (MO-Earth City) Zenith Administrators (MO-Kansas City) Zenith Administrators (NV) Zenith Administrators (OK) Zenith Administrators (TX) Zenith Administrators (WA- Seattle) Zenith Administrators (WA- Spokane) Zenith Administrators (WI- Deforest) Zenith Administrators (WI- Milwaukee) DORAL DENTAL Doral Dental USA** Doral Dental of WI (Policy # 0003)** Georgia Medicaid, Grady Healthcare, Inc. (Policy #0041)** Georgia Medicaid -Peachstate Health Plan ** Illinois Medicaid (Policy # 0054)** Kentucky Medicaid, Passport Plan Region #3 (Plcy # 0030)** Managed Health Services WI State Employees (Policy # 0013)** Maryland Medicaid, MD Physicians Care MCO (Plcy # 0026)** Missouri Medicaid, Blue Advantage (Policy # 0006)** Missouri Medicaid, Community Care Plus St Louis (Policy # 0028)** Missouri Medicaid, Community Health Plan (Policy # 0009)** Missouri Medicaid, First Guard Health Plan ( Policy # 0008)** Missouri Medicaid, HealthCare USA, St Louis (Policy # 0027)**

Payer ID CDMN1 TLA06 20333 TLY31 TLY10 TLX36 TLY11 TLY12 TLY14 TLY15 TLY16 TLY17 TLY18 TLY19 TLY20 TLY21 TLY13 TLY23 TLY22 TLY24 TLY25 TLZ33 TLY27 TLY28 TLY29 TLY30 CX014 CX014 CX014 CX014 CKIL1 CKKY3 CX014 CX014 CX014 CX014 CX014 CX014 CX014

Eligibility

X ** X ** X ** X ** X ** X ** X ** X ** X ** X ** X ** X ** X **

X X X

X X X X X X X

Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section *ecentral Insurance Managers customers should know that some Medicaid programs impose a fee for electronic verification of eligibility. These fees are charged per verification and are billed directly to the provider. Fees vary by Medicaid program. Contact your local Medicaid program for details. Please contact eServices Enrollment at 800.734.5561 for enrollment required forms and questions.

More On Next Page 8/31/2009

DORAL DENTAL Enrollment Required Attachment availability X ** X ** X ** X ** X ** X ** X ** X ** X ** X ** X ** X ** X ** X ** X ** X ** X ** X ** X ** X ** X ** X **

Payer Name Missouri Medicaid, Health Net (Policy # 0007)** Missouri Medicaid, Truman Care, Family Health Partners (Policy # 0010)** Nebraska Medicare United Health Care of the Midlands (Policy # 0001)** Anthem Partnership Plan in Nevada New Mexico Medicaid, Cimmeron Health Plan (Plcy # 0025)** New Mexico Medicaid Lovelace Community Health Plan (Policy # 0023)** New Mexico Medicaid, Presbyterian Salud (Policy # 0024)** Ohio Medicaid and Medicare Emerald HMO, Cincinnati, OH (Policy #0039)** Ohio Medicaid Health Power HMO Cincinnati, OH (Policy # 0019)** Ohio Medicaid, Personal Physicians Care Cleveland, OH (Policy # 0002)** Ohio Medicaid, United Healthcare, Inc. Medicare Complete (Policy # 0021)** Pennsylvania Medicaid, Best Health Care Pittsburg, PA (Policy # 0031)** Pennsylvania Medicaid, Gateway Health Plan Pittsburg, PA (Policy # 0017)** Pennsylvania Medicaid and Medicare Health Partners, Philadelphia, PA (Policy # 0005)** Pennsylvania Medicaid and Medicare, Oak tree (Plcy # 0038)** Physicians Plus Insurance Co. WI State Employees (Policy # 0040)** PimeCare, Wisconsin State & Federal Employees & Medicaid Policy # 0011)** Tennessee Medicaid, Bluecare (Policy # 0033)** Virginia Medicaid, Health Keepers Plus (Policy # 0037)** Medicaid of Tennessee Wisconsin Medicaid, Humana/TDC (Policy # 0042)** Xantus Health Plan Ten** DELTA DENTAL PAYERS AARP (Mechanicsburg, PA) AARP (Administrated by DD of Washington DC) Delta Care USA Claims Delta Dental Insurance Company (DDIC) Delta Dental of Alaska** Delta Dental of Alabama Delta Dental of Arizona Delta Dental of Arkansas

Payer ID CX014 CX014 CX014 CX014 CX014 CX014 CX014 CX014 CX014 CX014 CX014 CX014 CX014 CX014 CX014 CX014 CX014 CX014 CX014 CX014 CX014 CX014 AARP1 52147 DDCA2 94276 94276 94276 86027 CDAR1

Eligibility X X X X X X X X X X X X X X X X X X X X X X

X X X ** X ** X X

X X X X X X

Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section *ecentral Insurance Managers customers should know that some Medicaid programs impose a fee for electronic verification of eligibility. These fees are charged per verification and are billed directly to the provider. Fees vary by Medicaid program. Contact your local Medicaid program for details. Please contact eServices Enrollment at 800.734.5561 for enrollment required forms and questions.

More On Next Page 8/31/2009

DELTA DENTAL PAYERS Enrollment Required Attachment availability X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X

Payer Name Delta Dental of California (CA00 claim office) Delta Dental of California - Tricare Retiree Delta Dental of Colorado Delta Dental of Connecticut Delta Dental of Delaware Delta Dental of Florida Delta Dental of Georgia Delta Dental of Hawaii/ HDS Delta Dental of Idaho Delta Dental of Indiana Delta Dental of Iowa Delta Dental of Illinois Delta Dental of Kansas Delta Dental of Kentucky Delta Dental of Louisiana Delta Dental of Maine (Northeast) Delta Dental of Maryland (Pennsylvania) Delta Dental of Massachusetts DentaQuest (MA) Delta Dental of Michigan Delta Dental of Minnesota Delta Dental of Mississippi Delta Dental of Missouri Delta Dental in Missouri of South Carolina Delta Dental of Montana Delta Dental of Nebraska Delta Dental of Nevada Delta Dental of New Hampshire (Northeast) Delta Dental of New Jersey & Connecticut Delta Dental of New Mexico Delta Dental of New York Delta Dental of North Carolina Delta Dental of North Dakota Delta Dental Northeast (ME, NH, VT) Delta Dental of Ohio Delta Dental of Oklahoma Delta Dental of Oregon (Oregon Dental Services)** Delta Dental of Pennsylvania Delta Dental of Rhode Island Delta Dental of South Carolina Delta Dental of South Dakota**

Payer ID 77777 CDCA1 84056 22189 51022 94276 94276 DEHI1 82029 CDIN1 CDIA1 05030 CDKS1 CDKY1 94276 02027 23166 04614 04356 CDMI0 CDMN1 94276 43090 43091 94276 CDNE1 94276 02027 22189 85022 11198 56101 CDND1 02027 CDOH1 CDOK1 CDOR1 23166 05029 43091 54097

Eligibility X

X X X ** X X X **

X X X X

Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section *ecentral Insurance Managers customers should know that some Medicaid programs impose a fee for electronic verification of eligibility. These fees are charged per verification and are billed directly to the provider. Fees vary by Medicaid program. Contact your local Medicaid program for details. Please contact eServices Enrollment at 800.734.5561 for enrollment required forms and questions.

More On Next Page 8/31/2009

DELTA DENTAL PAYERS Enrollment Required Attachment availability X

Payer Name Delta Dental of Tennessee Delta Dental of Texas Delta Dental of Utah Delta Dental of Virginia** (Attachment is electronic, claim submitted by paper) Delta Dental of West Virginia Delta Dental Vermont (Northeast) Delta Dental of Washington Delta Dental of Washington DC Delta Dental of Wisconsin Delta Dental of Wyoming BLUE CROSS BLUE SHIELD PAYERS Anthem BC/BS (IN, OH, KY, CT, & NH) Blue Cross Blue Shield of Alabama Blue Cross Blue Shield of Alaska (Premera) Premera Blue Cross (AK) Blue Cross Blue Shield of Arizona Blue Cross Blue Shield of Arizona- FEP Claims Blue Cross Blue Shield of Arkansas (Blue Advantage) Blue Cross Blue Shield of Arkansas-FEP Blue Cross of California (WellPoint Dental) (Anthem) Blue Cross Blue Shield of Colorado Dental Trigon Blue Cross Blue Shield - CO Dental Office Blue Cross Blue Shield of Connecticut (Anthem) Blue Care Family Plan (BC/BS of CT) Blue Cross Blue Shield of Delaware Blue Cross Blue Shield of Florida Florida Combined Life (BCBS of FL) Blue Cross Blue Shield of Georgia Blue Cross Blue Shield of Hawaii- Commercial Claims Blue Cross Blue Shield of Hawaii- Federal Claims-FEP Blue Cross of Idaho (Only Idaho Residents may submit) Blue Shield of Idaho (Only Idaho Residents may submit) Blue Cross Blue Shield of Illinois Blue Cross Blue Shield of Illinois (FEDERAL Claims) Blue Cross Blue Shield Indiana (Anthem) Blue Cross Blue Shield Indiana (FEP Claims) Blue Cross Blue Shield of Iowa (Wellmark Blue Dental) Blue Cross Blue Shield of Iowa- Fep & Farm Bureau Blue Cross Blue Shield of Kansas (Kansas providers. only) Blue Cross Blue Shield of Kentucky (Anthem)

Payer ID CDTN1 94276 94276 54084 31096 02027 91062 52147 39069 CDWY1 84105 CBAL1 47570 47570 TBX01 TLZ14 TLY26 TFQ45 47198 84099 84103 84105 00700 53287 BFL01 BFL01 CBGA1 HMSA1 HMSA2 CBID1 CBID2 CB621 TLW12 84105 TLU89 CBIA2 CBIA1 CBKS1 84105

Eligibility X X X

X ** X X X X X X X X X X X X X

X X X

X

X X X X X X X X X X X X X

Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section *ecentral Insurance Managers customers should know that some Medicaid programs impose a fee for electronic verification of eligibility. These fees are charged per verification and are billed directly to the provider. Fees vary by Medicaid program. Contact your local Medicaid program for details. Please contact eServices Enrollment at 800.734.5561 for enrollment required forms and questions.

More On Next Page 8/31/2009

BLUE CROSS BLUE SHIELD PAYERS Enrollment Required X X X Attachment availability

Payer Name Blue Cross Blue Shield of Kentucky (FEP Claims) Blue Cross Blue Shield of Louisiana Blue Cross Blue Shield of Maine (Anthem) Blue Cross Blue Shield of Maryland- Care First Blue Cross Blue Shield of Maryland- Care First- FEP ONLY Blue Cross Blue Shield of Maryland- Care First- BLUE CHOICE ONLY Blue Cross Blue Shield of Massachusetts (Participating providers only) Blue Cross Blue Shield of Michigan** Blue Cross Blue Shield of Minnesota Blue Cross Blue Shield of Minnesota (Federal FEP) Blue Cross Blue Shield of Mississippi Blue Cross Blue Shield of Mississippi (FEP Claims) Blue Cross Blue Shield of Mississippi (CHIPS Claims) Blue Cross Blue Shield of Missouri Blue Cross Blue Shield Montana Blue Cross Blue Shield of Nebraska Blue Cross Blue Shield of Nevada Blue Cross Blue Shield of New Hampshire (Anthem) Blue Cross Blue Shield of New Mexico Blue Cross Blue Shield of NY- Central NY (Excellus) Blue Cross Blue Shield of Rochester NY (Excellus) Blue Cross Blue Shield of New York (Finger Lakes Region) Blue Cross Blue Shield of NY- Syracuse (Excellus) Blue Cross Blue Shield of NY- Utica Watertown (Excellus) Blue Cross Blue Shield of North East NY Blue Cross Blue Shield of Western NY Empire Blue Cross & Blue Shield of New York (Participating providers only) Horizon Health Care of NY Horizon Healthcare Dental Services (NY, NJ) Horizon Blue Cross Blue Shield of New Jersey Blue Cross Blue Shield of NC (Winston-Salem, NC) Blue Cross Blue Shield of NC Federal Employee Program Blue Cross Blue Shield of NC-DBS (a.k.a. ACS Benefit Services) Blue Cross Blue Shield of North Dakota (ND Dental Service) Blue Cross Blue Shield of Ohio (Anthem) Blue Cross Blue Shield of Ohio (FEP Claims) Blue Cross Blue Shield of Oklahoma Blue Cross Blue Shield of Oregon (Regence)

Payer ID TLU90 23739 BME01 TLX88 TLX85 TLX86 CBMA1 CBMI1 BXMN1 TLU22 TBS01 TBS02 TBS03 TLX52 CBMT1 CBNE1 84101 84105 CBNM1 EXC02 EXC01 EXC01 EXC02 EXC01 CBNYE CBNYW CBNY1 22099 22099 22099 61473 61472 61474 CX004 84105 TLU91 TBOK1 CB850

Eligibility

X

X X **

X

X X X X X X X X X X X X X X X X X X X X X X X X X X X

Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section *ecentral Insurance Managers customers should know that some Medicaid programs impose a fee for electronic verification of eligibility. These fees are charged per verification and are billed directly to the provider. Fees vary by Medicaid program. Contact your local Medicaid program for details. Please contact eServices Enrollment at 800.734.5561 for enrollment required forms and questions.

8/31/2009

BLUE CROSS BLUE SHIELD PAYERS Payer Name Blue Cross Blue Shield of Oregon (Regence) - FEP CLAIMS Blue Cross Blue Shield of PA (Dental Plus) Blue Cross Blue Shield of Pennsylvania (Camp Hill) (Federal) Blue Cross Blue Shield of Rhode Island Blue Cross Blue Shield of South Carolina Blue Cross Blue Shield of South Carolina (Federal ONLY) Blue Cross Blue Shield of South Dakota Blue Cross Blue Shield of Tennessee Blue Cross Blue Shield of Texas Blue Cross Blue Shield of Utah (UHIN) Blue Cross of Utah (Regence) - FEP Blue Cross Blue Shield of Vermont Blue Cross of Virginia (Trigon) Blue Cross of West Virginia Blue Cross of Washington and Alaska (Premera Blue Cross) Regence Blue Shield of Washington Regence Northwest Health (BCBS WA) Blue Cross Blue Shield of Washington DC Blue Cross Blue Shield of Wisconsin Blue Cross Blue Shield of Wyoming WellPoint Dental (Blue Care Family) MEDICAID PAYERS Medicaid of Alabama Medicaid of Alaska Medicaid of Arizona (APIPA ONLY) Medicaid of Arizona (APIPA-CRS) Medicaid of Arizona Medicaid of Arkansas Medicaid of California (Denti-Cal) Medicaid of Colorado (ACS) Medicaid of Connecticut Medicaid of Delaware Medicaid of District of Columbia Medicaid of Florida (ACS) Medicaid of Georgia (ACS)** Medicaid of Georgia (HFP) Medicaid of Georgia (Peach Care for Kids) Medicaid of Hawaii (ACS Consulting Services) Medicaid of Idaho Medicaid of Illinois** Medicaid of Indiana Indiana Children's Special Health Care Payer ID TLW13 CBPA2 CB865 CB870 BSC01 TLW74 TLY09 CBTN1 CB900 CBUT1 CBUTF TLX57 CB923 TLY46 47570 93200 93200 TLY47 CB950 TLX12 47198 CKAL1 CKAK1 TLW68 APCRS TLU09 CKAR1 94146 CKCO1 CKCT1 CKDE1 CKDC1 CKFL1 CKGA1 CKGA2 CKGA3 ACSH1 CKID1 CKIL1 CKIN1 CX070 X X X ** X X X X X X X X ** X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X Enrollment Required Attachment availability Eligibility

Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section *ecentral Insurance Managers customers should know that some Medicaid programs impose a fee for electronic verification of eligibility. These fees are charged per verification and are billed directly to the provider. Fees vary by Medicaid program. Contact your local Medicaid program for details. Please contact eServices Enrollment at 800.734.5561 for enrollment required forms and questions.

8/31/2009

MEDICAID PAYERS Payer Name Medicaid of Iowa (Noridian) Medicaid of Kansas (Kansas providers only) Medicaid of Kentucky Medicaid of Kentucky Doral/Region 3** Medicaid of Louisiana (Adult Dental) Medicaid of Louisiana (EPSDT) Medicaid of Maine Medicaid of Maryland Dep. Of Health & Mental Hygiene Medicaid of Massachusetts / Mass Health (Unisys) Medicaid of Michigan Health Partners of Minnesota-Medicaid Medicaid of Minnesota DHS (A MN Medical Assistance Plan) (St. Paul, MN) Medicaid of Mississippi Medicaid of Missouri (administrated by GTE Data Services) Medicaid of Missouri (a.k.a. MO Healthnet) Medicaid of Montana Medicaid of Nebraska Medicaid of Nevada Medicaid of New Hampshire Medicaid of New Jersey (Unisys) Medicaid of New Mexico (ACS/Consultec) Medicaid of New York (Category of Service 0200 ONLY) Medicaid of New York Medicaid of North Carolina Medicaid of North Dakota Medicaid of Ohio Medicaid of Ohio (Care Source) Medicaid of Oklahoma (Provider # Required at Clearinghouse) Medicaid of Oregon Medicaid of Pennsylvania Medicaid of Rhode Island Medicaid of South Carolina Medicaid of South Dakota Medicaid of Texas (ACS) Medicaid of Utah Medicaid of Vermont Medicaid of Virginia (Richmond, VA)** Medicaid of Washington (DSHS)** Medicaid of West Virginia (Unisys) Medicaid of Wisconsin Medicaid of Wyoming (ACS) Payer ID CKIA1 CKKS1 CKKY1 CKKY3 CKLA2 CKLA1 CKME1 CKMD1 CKMA1 CKMI1 CX010 CKMN1 CKMN1 CKMS1 CKMO1 CKMO1 CKMT1 MCNE1 CKNV1 CKNH1 CKNJ1 CKNM1 CKNY1 CKNY2 CKNC1 CKND1 CKOH1 CKOH2 CKOK1 CKOR1 CKPA1 CKRI1 CKSC1 TLZ29 CKTX1 CKUT1 CKVT1 CKVA1 CKWA1 CKWV1 CKWI1 CKWY1 X X X X X X X ** X ** X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X ** X X X X Enrollment Required X Attachment availability Eligibility X X X

Paper Claim submission please use payer ID 06126. / ** Attachment requires additional info in notes section *ecentral Insurance Managers customers should know that some Medicaid programs impose a fee for electronic verification of eligibility. These fees are charged per verification and are billed directly to the provider. Fees vary by Medicaid program. Contact your local Medicaid program for details. Please contact eServices Enrollment at 800.734.5561 for enrollment required forms and questions.

8/31/2009

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